Early Serum Proteomic Diagnosis and Classification of Preeclampsia Preeclampsia accounts for 15% of all maternal deaths in pregnancy, complicates over 160,000 pregnancies in US, and costs our health care system 7 billion dollars a year. Additionally, preeclampsia has dire consequences for the fetus including death and long term disability from attendant intrauterine growth retriction and prematurity. Preeclampsia has increased over 40% over the last decade (WHO) and disproportionately affects minority groups. Despite significant reasearch effort there is no early test for preeclampsia or effective treatment: the complex spectrum of disease and the elusive pathologic factors released by the placenta that damage the maternal vascular system have remained significant obstacles to these goals. Understanding the status of the maternal serum proteome and how it mediates preeclampsia is critical for early diagnosis and eventual treatment. We plan to collect maternal serum from preeclamptic mothers at three time points; at labor, at onset and prospectively at 15-20 weeks gestation. Proteins and peptides present in preeclamptic serum will be compared to normal controls. Discovering and evaluating a large number of peptides requires the use of a high throughput mass spectrometer and a neural-network bioinformatic algorithm. Discriminating proteins and peptides will be correlated with clinical outcome, presentation and severity of disease. Through this method we hope to develop an early serum test for preeclampsia that stratifies patients according to potential severity and treatment response. This "biosignature" can be monitored in real-time for treatment efficacy. Constituent proteins and peptides discriminating disease, outcome and response will be identified to determine those serum factors responsible for transmitting the placental disease to the mother.